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Y1 Gastrointestinal > Hepatomegaly and Focal Liver Lesions > Flashcards

Hepatomegaly and Focal Liver Lesions Flashcards

1
Q

is a solid liver lesion more likely to be malignant in a younger or older patient?

A

older

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2
Q

what is more common in the absence of liver disease, primary liver cancer or metastases to the liver?

A

metastases to the liver

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3
Q

what is the most common solid liver tumour in non-cirrhotic patients?

A

haemangioma

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4
Q

name four benign liver lesions

A

haemangioma
focal nodular hyperplasia
adenoma
liver cysts

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5
Q

name two primary liver cancers

A

hepatocellular carcinoma

cholangiocarcinoma

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6
Q

what is the most common liver tumour?

A

haemangioma

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7
Q

is haemangioma more common in males or females?

A

females

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8
Q

describe the appearance of haemangioma

A

usually one, small tumour

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9
Q

what symptoms are usually present with haemangioma?

A

none

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10
Q

what investigations are done into haemangioma?

A

ultrasound
CT
MRI

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11
Q

what is seen on an ultrasound of a haemangioma?

A

a well demarcated echogenic spot

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12
Q

what is seen on a CT of a haemangioma?

A

venous enhancement from the periphery to the centre

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13
Q

what treatment is done for haemangioma?

A

none

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14
Q

what happens in focal nodular hyperplasia (FNH)?

A

a benign nodule of normal liver tissue forms

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15
Q

what causes focal nodular hyperplasia?

A

a congenital vascular anomaly

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16
Q

name two conditions associated with focal nodular hyperplasia

A

osler-webb-rendu

haemangioma

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17
Q

what does FNH look like when imaged?

A

a central scar containing a large artery, with radiating branches to the periphery

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18
Q

what age group and gender most commonly gets FNH?

A

young/middle aged women

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19
Q

what symptoms are associated with FNH?

A

none or minimal pain

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20
Q

what is FNH?

A

focal nodular hyperplasia

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21
Q

what four investigations are done for suspected FNH?

A

ultrasound
CT
MRI
FNA

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22
Q

what is FNA?

A

fine needle aspiration

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23
Q

what is seen on ultrasound in FNH?

A

a nodule with varying echogenicity

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24
Q

what is seen on CT in FNH?

A

a hypervascular mass with a central scar

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25
Q

what is seen on FNA in FNH?

A

normal hepatocytes and kupffer cells with a central core

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26
Q

what treatment is done for FNH?

A

none is necessary

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27
Q

what is a hepatic adenoma?

A

a benign neoplasm composed of normal hepatocytes

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28
Q

is hepatic adenoma more common in males or females?

A

females

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29
Q

what two chemicals are associated with hepatic adenoma?

A

contraceptive hormones

anabolic steroids

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30
Q

what symptoms are associated with hepatic adenoma?

A

none

may have RUQ pain

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31
Q

what rare ways may hepatic adenoma present?

A

rupture
haemorrhage
malignant transformation

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32
Q

is malignant transformation of hepatic adenoma more common in males or females?

A

males

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33
Q

what lobe is most commonly affected by hepatic adenoma?

A

the right lobe

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34
Q

what is adenomatosis?

A

multiple adenomas in the liver

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35
Q

what is adenomatosis associated with?

A

glycogen storage diseases

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36
Q

what four investigations may be done into hepatic adenoma?

A

ultrasound
CT
MRI
FNA

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37
Q

what conservative treatment can be done for hepatic adenoma?

A

stop hormones

lose weight

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38
Q

what should be done for adenomas present in males?

A

surgical excision, irrespective of size

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39
Q

what is done for hepatic adenomas in females?

A

imaging after six months

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40
Q

what is done for a hepatic adenoma under 5cm or reducing in size in females?

A

an annual MRI

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41
Q

what is done for a hepatic adenoma over 5cm or increasing in size in females?

A

surgical excision

42
Q

what five types of cystic lesions can be present in the liver?

A 
simple
hydatid 
atypical
polycystic 
amoebic abscess
43
Q

what is a simple cyst?

A

a liquid collection lined by an epithelium

44
Q

what are complications of a simple cyst that can cause symptoms?

A

intracystic haemorrhage
infection
rupture
compression

45
Q

what causes a hydatid cyst?

A

Echinococcus granulosus

46
Q

what can patients with a hydatid cyst present with?

A

disseminated disease

erosion of cysts into adjacent structures and vessels

47
Q

what vessel do hydatid cysts commonly erode into?

48
Q

what two methods can be used to manage a hydatid cyst?

A

surgery

percutaneous drainage

49
Q

what drug can be given to treat a hydatid cyst?

A

albendazole

50
Q

what is the most common way to treat a hydatid cyst?

51
Q

what conservative surgery can be done for a hydatid cyst?

A

open cystectomy

52
Q

what radical surgeries can be done for a hydatid cyst?

A

pericystectomy

lobectomy

53
Q

what is present in polycystic liver disease?

A

numerous cysts throughout the liver parenchyma

54
Q

what is PLD?

A

polycystic liver disease

55
Q

what are the three types of PLD?

A

von meyenburg complexes (VMC)
polycystic liver disease
autosomal dominant polycystic kidney disease (ADPKD)

56
Q

what is VMC?

A

von meyenburg complexes

57
Q

what are von meyenburg complexes?

A

benign cystic nodules throughout the liver

58
Q

what is ADPKD?

A

autosomal dominant polycystic kidney disease

59
Q

what does ADPKD commonly cause?

A

renal failure

60
Q

what genes are affected in ADPKD?

A

PKD1 and PKD2

61
Q

what genes are affected in polycystic liver disease?

A

PRKCSH and SEC63

62
Q

name two common symptoms of PLD

A

abdominal pain

distension

63
Q

what type of treatment is recommended in PLD and why?

A

conservative, to halt cyst growth and reduce symptoms

64
Q

when is invasive treatment required for PLD?

A

when patients have advanced disease

65
Q

what invasive treatment can be done for PLD?

A

aspiration

liver transplantation

66
Q

what pharmacological therapy can be given for PLD?

A

somatostatin analogues

67
Q

what three things does a liver abscess commonly cause?

A

high fever
leukocytosis
abdominal pain

68
Q

what two things in a history can indicate towards a liver abscess?

A

abdominal/biliary infection

dental procedures

69
Q

what investigation can be done for a liver abscess?

A

echocardiogram

70
Q

what is the initial management of a liver abscess?

A

empiric broad spectrum antibiotics

aspiration/drainage

71
Q

what is done for liver abscesses if there is no clinical improvement

A

open drainage or resection

72
Q

what follow up treatment is done for patients with liver abscesses?

A

four weeks of antibiotic therapy and repeat imaging

73
Q

name four malignant liver lesions

A

hepatocellular carcinoma
fibrolamellar carcinoma of the liver
hepatoblastoma
intrahepatic cholangiocarcinoma

74
Q

what does HCC stand for?

A

hepatocellular carcinoma

75
Q

what is the most common primary liver cancer?

A

hepatocellular carcinoma

76
Q

is HCC more common in men or women?

77
Q

what is the most important risk factor for HCC?

A

cirrhosis of any cause

78
Q

name four clinical features of HCC

A

weight loss
RUQ pain
worsening pre-existing chronic liver disease
acute liver failure

79
Q

what is seen on examination of HCC?

A

signs of cirrhosis
hard, enlarged RUQ mass
liver bruit

80
Q

where can HCC metastasise to?

A

portal vein
lungs
bones
the brain

81
Q

what protein is a marker for HCC?

82
Q

what is AFP?

A

alfa feto protein

83
Q

what value of AFP is seen in the majority of HCC patients?

84
Q

what is the best possible treatment for HCC?

A

liver transplant

85
Q

when is liver transplant done in HCC?

A

one tumour <5cm OR 3 tumours <3cm

86
Q

when is resection feasible for HCC?

A

small tumours with preserved liver function

87
Q

what two things rule out resection for HCC?

A

jaundice

portal hypertension

88
Q

what treatment is done for HCC in non-resectable patients or those with advanced liver cirrhosis?

A

local ablation

89
Q

what two methods can be used for local ablation of HCC?

A

alcohol injection

radiofrequency ablation

90
Q

what is TACE?

A

trans arterial chemoembolization

91
Q

what does TACE involve?

A

injecting chemotherapy and then an embolic agent into a hepatic artery

92
Q

who gets TACE?

A

HCC patients with early cirrhosis

93
Q

who can’t get TACE?

A

patients with metastatic disease

94
Q

who does fibrolamellar carcinoma present in?

A

young patients from 5-35

95
Q

what is AFP like in fibrolamellar carcinoma?

A

it is normal

96
Q

what does a CT of fibrolamellar carcinoma show?

A

a stellate scar with radial septa

97
Q

what is the standard care for fibrolamellar carcinoma?

A

surgical resection or transplant

98
Q

what is the treatment for unresectable fibrolamellar carcinoma?

99
Q

what is the most common site for blood born metastases?

100
Q

how is a liver metastasis diagnosed?

A

imaging or FNA

Y1 Gastrointestinal (48 decks)

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